Sunday, October 16, 2016

Autism spectrum disorder
(ASD) affects approximately 1 to 2 % of the school-age population. The majority of children with autism are
educated within the public school system, most often in general education classes,
either full- or part-time. Thus, teachers (regular and special education) and
other school personnel must be familiar with current best practices for identifying
and treating children with ASD. However, many do not have formal training in
educating and intervening with this group of children. To address the increased
need for services in school settings, it has been recommended that school
personnel participate in trainings to develop the skills and competencies necessary
to provide effective services to students with ASD. Although a review of the
literature suggests that school personnel are receiving some specialized
training related to autism, there continues to be a pressing need for more continuing
education opportunities and improved preparation. It is vital that school
personnel understand this complex disorder in order to help students achieve
positive outcomes, especially since they share the responsibility of educating
the increasing number of children being identified with ASD.

Pilot Study

Although there is a
paucity of research focusing on school personnel's perceived and/or factual
knowledge of autism, a pilot survey published in the School
Psychologist provides us with an exploratory investigation of teacher,
counselor, and paraprofessional knowledge of autism. The survey attempted to
answer the following questions: (a) To what extent do school personnel
(teachers, counselors, and paraprofessionals) perceive that they are competent
in their understanding of autism?; (b) What is school personnel's factual knowledge
of autism (definition, assessment/diagnosis, and treatments)?; and (c) To what
extent do school personnel that work directly with students with autism differ
in their perception and factual knowledge of autism in comparison to those who
do not work with students with autism?

Participants

Fifty-four school
personnel from a southwestern state participated in the pilot survey. Participants
were school district employees enrolled in various graduate level majors who
were attending a small university (within the college of education) in the
Southwestern United States. The sample included 26 general education teachers,
14 special education teachers, 7 school counselors and 7 paraprofessionals. Seventy
percent indicated that they worked directly with students diagnosed with autism
(instructor, interventionist, care-provider, etc.), while approximately 30
percent indicated that they indirectly served students with autism (consultant,
academic planning, multidisciplinary team member, etc.). A majority indicated
that they had never participated in autism training(s) and when asked whether
they would like to take part in future training(s), most indicated that they
did not have a desire to participate.

Participants completed two
measures developed by the authors, a Perceptions Survey and a Knowledge Survey.
Both measures contained items derived from empirically-supported findings in
the research literature. The Perceptions Survey items were designed to assess
the respondents' perceived competence of their knowledge and ability to
implement research findings. The Knowledge Survey items were designed to assess
the respondents' factual knowledge of research findings about autism (definition,
assessment/diagnosis, and treatment).

Results

The results of the survey indicated
that overall, the perceived competence of general and special education
teachers, school counselors, and paraprofessional regarding their knowledge of
autism was average. Although school personnel that work directly and indirectly
with students both reported having average perceived competence, those
providing direct service had a statistically significantly higher level of perceived
competence. The results of the Knowledge Survey indicated that school personnel
who work directly with students correctly defined the disorder, while those
that do not demonstrated moderate knowledge with some errors. However, school
personnel's factual knowledge about the assessment/diagnosis and treatment of
autism was low, regardless of whether services were delivered directly or
indirectly.

Discussion

The findings of this pilot
survey raise several important questions about school personnel’s perceived and
factual knowledge about autism. A majority of participants indicated they had
no prior training and expressed little interest in receiving education related
to autism in the future. This is concerning, given that all participants working
with students with autism, either directly or indirectly, reported average perceived
competence yet demonstrated a low level of factual knowledge. This divergence suggests
that teachers, school counselors, and paraprofessionals may overestimate their
factual knowledge about autism and as a result, fail to see a need for
additional training.

Despite the study’s
limitations (e.g., small sample size) and need for further research relating to
school personnel’s perceptions and knowledge, the results have significant implications
for school-based practice. For example, administrators, supervisors, and
support professionals such as school psychologists should exercise caution when
assuming that school personnel have an adequate factual understanding and
working knowledge of autism. It is also important to recognize that anecdotal
reports are insufficient when determing the need for training and that direct
assessment of factual knowledge is required. Failure to correctly identify
training needs can have a negative effect on screening/assessment and
intervention selection, planning, and implementation. The results also raise an
important question as to what extent school personnel’s perceived knowledge
about autism might limit their willingness to participate in training and
contribute to resistance in consultation.

Concluding Comments

There is a critical need
for more coordinated efforts among community and school professionals for the
training of teachers in evidence-based instruction and behavioral management
practices for children with ASD. Because the knowledge base in ASD is changing
so rapidly, it is imperative that school personnel remain current with the
research and up to date on scientifically supported approaches that have direct
application to the educational setting. For example, some intervention and
assessment procedures require a specific knowledge base and skills for
successful implementation. It is vital that service providers understand best
practice procedures across school, community, and home settings. School personnel
can help to ensure that students with ASD receive an effective educational
program by participating in training programs designed to increase their understanding
and factual knowledge about assessment and intervention /treatment approaches.

Friday, October 14, 2016

Suicide and suicidal
ideation are serious public health problems among youth in the United States. Suicide
is the third leading cause of death among individuals between the ages of 10
and 14, and the second leading cause of death among individuals between the
ages of 15 and 24.More teenagers and young adults die from suicide than
from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza,
and chronic lung disease, combined. It is
estimated that 1 in 12 high school students may attempt suicide each year and
that more than 2 million adolescents aged 12 to 17 suffered a major depressive
episode in the past year. Moreover, estimates for suicide deaths in younger age
groups tend to be conservative because suicide deaths may be misclassified as
accidental or undetermined. The extant research indicates a strong relationship between depression and
suicidal ideation or attempts.

Children and youth on the autism spectrum (ASD) frequently have co-occurring (comorbid) psychiatric
conditions, with rates significantly higher than would be expected from the
general population. In fact, depression is one of the most common comorbid
conditions observed in individuals with ASD, particularly higher functioning
youth. Studies of psychiatric comorbidity in young adults with ASD revealed
that a majority had experienced at least one episode of major depression and reported
recurrent major depression. Although depression is frequent in autism, there is
little research available on suicidal ideation and attempts in children and
youth with ASD. This knowledge is critical to help identify at-risk children
and target risk factors for intervention in order to reduce and prevent suicide
ideation and attempts.

Research

Experts agree that much
needs to be learned about suicide ideation and attempts, depression, and other
psychiatric comorbidities in ASD. A study published in Research in Autism Spectrum
Disorders examined the frequency of suicide ideation and attempts, as
well as risk factors in 791 children with autism (1–16 years), 35 depressed
children without ASD, and 186 typical children. Mothers rated their
children on a 4-point scale from “not at all a problem” to “very often a
problem” on a 165-item pediatric behavior scale (PBS). Dependent variables were
two items assessing suicide ideation (“talks about harming or killing self”)
and attempts (“deliberately harms self or attempts suicide”). Co-occurring
problems scores on the PBS included teased by peers; behavior problems (e.g.,
disobedient, defiant, and aggressive); mood dysregulation (e.g., explosive, irritable,
and temper tantrums); attention deficit, impulsive; hyperactive, anxious,
depressed, poor peer relationship (e.g., difficulty making friends); psychotic
features (e.g., hallucinations and confusing fantasy and reality); underaroused
(e.g., drowsy and sluggish), eating disturbance (e.g., poor appetite, over
eating, binging, and purging); excessive sleep, sleeping less than normal and
difficulty falling and staying asleep; and somatic complaints (e.g., headaches and
stomachaches).

Results

Data analyses compared scores between the children with autism, depression, and typical development. Age,
IQ, gender, race, socio-economic status (SES), autism severity, teased, and comorbid
psychological problem scores also analyzed to predict children whose mothers
rated suicide ideation or attempts as sometimes to very often a problem versus
never a problem. The results indicated that
the percentage of children with autism who had ideation or attempts was 28
times greater than that for typical children, but less than for depressed
children. For children with autism, four demographic variables (age 10 or
older, minority status, lower SES, and male) were significant risk factors of
suicide ideation or attempts. The majority of children (71%) who had all four
demographic risk factors had ideation or attempts. Comorbid psychological
problems most highly predictive of ideation or attempts were depression, behavior
problems, and being teased or bullied. Almost half of children with these problems had suicide ideation
or attempts. Depression was the strongest single predictor of suicide ideation
or attempts in children with autism with 77% of children with ideation or
attempts considered by their mothers to be depressed. A significant finding was
that there was no difference in the frequency of suicide ideation or attempts
between higher functioning children with ASD and those children with more
severe impairment (e.g.., intellectual disability).

Implications

This study provides
important information regarding the risk factors related to suicide in children
and youth with ASD. A major finding is that many of the predictors of and
variables associated with suicide behavior in adolescent and adult psychiatric
and nonpsychiatric samples are also found in children with ASD. For example,
ideation or attempts were associated with behavior problems (disobedient,
defiant, and aggressive), impulsivity, and mood dysregulation (explosive,
irritable, and temper tantrums). Children with these externalizing problems
combined with the internalizing problem of depression are at high risk for
suicide ideation and attempts. Teasing and bullying by peers is a common problem
for children on the spectrum and was reported by a majority of mothers in the
study. Suicide ideation or attempts were three times more frequent in children
who were teased than in those not teased. The finding that the frequency of
suicide ideation and attempts did not differ as a function of severity or IQ also
suggests that many of the correlates of suicide behavior apply across the
entire autism spectrum.

The authors recommend that
all children with ASD be screened for suicide ideation or attempts because the
frequency of ideation and attempts is significantly higher than in typical
children and does not differ as a function of autism severity or IQ. This is
especially important for children who have demographic and comorbid risk
factors, including age 10 or older, male, minority status, lower SES, teased,
depressed, impulsive, behavior problems, and mood dysregulation. Practitioners
must fully be aware of the risk of suicide along with preventative and
treatment methods. Addressing suicide in youth relies on prevention techniques
and modification of risk factors, along with therapeutic intervention once
children are identified as at-risk. Evidence-based techniques to reduce
depression and prevent suicide should be incorporated into programs and
services for children with ASD who present with risk factors. This should include
interventions aimed at addressing co-occurring problems that may contribute to suicidal
ideation and attempts, such as teasing, depression, behavior problems, impulsivity,
and mood dysregulation. Lastly, future research should investigate other
predictors (e.g., previous attempts, negative life events, family history of
suicide, and biologic and neurochemical variables), which may improve
identification of children at risk for suicide ideation and attempts.

Wednesday, October 5, 2016

This 3-hour online
continuing education course, Autism Spectrum Disorder: Evidence-Based Screening & Assessment, is APA-approved and available for
credit for school psychologists. Epidemiological
studies indicate a progressively rising prevalence trend for autism spectrum
disorders (ASD) over the past decade. School professionals and clinicians must be prepared to recognize the presence of risk factors and/or early
warning signs of ASD and be familiar with screening and assessment tools in
order to ensure that students are being identified and provided with
the appropriate programs and services. The objectives of this
course are to identify DSM-5 diagnostic changes in the ASD diagnostic
criteria, summarize the empirically-based screening and assessment methodology
in ASD, and describe a comprehensive developmental approach for assessing
children, adolescents, and young adults with ASD.Course
#30-69 | 44 pages | 40 posttest questions. CE Credit: 3 Hours

Learning Objectives

Identify the changes in
the new DSM-5 criteria for ASD

Distinguish between DSM
diagnosis and IDEA classification schemes

Identify the three
levels of a multi-tier assessment strategy to screen for ASD

List the components of a
comprehensive developmental assessment for ASD

Professional Development
Resources is approved by the American Psychological Association (APA)
to sponsor continuing education for psychologists; by the Continuing
Education Board of the American Speech-Language-Hearing Association (ASHA Provider
#AAUM) to provide continuing education activities in speech-language pathology
and audiology;
by the National Board of Certified
Counselors (NBCC) to offer home study continuing education for NCCs (Provider
#5590); by the Association of Social Work Boards (ASWB Provider #1046, ACE
Program); by the National Association of Alcoholism & Drug Abuse Counselors
(NAADAC Provider #000279); by the American Occupational Therapy
Association (AOTA Provider #3159); by the Commission on Dietetic
Registration (CDR Provider #PR001); by the California Board of
Behavioral Sciences (#PCE1625); by the Florida Boards of Social Work,
Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology
& School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and
Occupational Therapy Practice (#34); by the Illinois DPR for Social
Work (#159-00531); by the Ohio Counselor, Social Worker & MFT
Board (#RCST100501); by the South Carolina Board of Professional
Counselors & MFTs (#193); and by the Texas Board of Examiners of
Marriage & Family Therapists (#114) and State Board of Social Worker
Examiners (#5678).

Tuesday, October 4, 2016

Young adults on the autism
spectrum face significant challenges as they transition to adulthood,
with many being socially isolated, unemployed, and lacking
services. Unfortunately, research suggests that the vast majority of these young
adults will be residing in the parental or guardian home during
the period of emerging adulthood. It is clear that more needs to be done to
help them thrive to the best of their abilities and attain a
high quality of life. "The Loving Push” by Drs. Grandin and Moore addresses these issues with a direct, yet empathetic and positive discussion of ways in which
parents and professionals can enhance the potential of "spectrum kids"
of any age and help them achieve productive and meaningful adult lives.

The authors convey a critical message that, more than other children and youth, those
on the autism spectrum must overcome "learned helplessness" and move beyond their comfort zone in order to reach
their full, unique potential. Pushing is necessary,” the authors write, “because those on
the spectrum are unlikely to automatically pick up the mundane but necessary
tasks of daily life without us intentionally nudging them and providing them
with information, encouragement, and persistence.”

"The Loving Push" consists of Three
Parts: Part I -The Path to Success Starts Here: Restoring Hope; Part –II:
Stretching Your Child & Avoiding Pitfalls; and Part III: Preparing Your
Child for Adulthood. Each part features Chapters containing important
information, lessons, tips, and advice on how to “Lovingly Push” youth on the
spectrum to reach their potential and achieve a successful transition to
adulthood. The book begins by sharing 8 inspiring profiles of persons on the
spectrum and using their real-life stories to illustrate the three essential
components of success: “Avoiding Learned Helplessness, Learning
Optimism/Resisting Habitual Negative Thinking, and The Critical Impact of
Mentors.” The section on “Getting Families and Schools to Work Together” is
especially important, given that transition planning is a critical part of
preparing students for life after high school and producing the best outcomes.
Young adults on the spectrum are particularly vulnerable during the initial
years in the transition to adulthood when there is a shift in service provision
after leaving high school. The authors recommend that teachers, parents, and
professionals “lovingly” guide, push, and mentor our children and youth as early
as possible, and for as long as possible.

The book also addresses
the issue of co-occurring anxiety and depression. The authors discuss counseling and evidence-based psychotherapy
approaches such as cognitive-behavioral therapy (CBT) and “mindfulness”
techniques to reduce stress, and improve mood and psychological well-being.
Group support for children, teens, and parents is referenced, as well as important commentary on
“Psychotherapy Approaches Not Recommended.” Tips and cautions about medication
use for anxiety and depression are also discussed.

“The Loving Push” devotes
considerable attention to the problem of compulsive electronic gaming and how
it can turn kids on the spectrum into “media recluses” and social isolates.
Since children and youth on the spectrum tend to engage in restricted and
repetitive behaviors, they are at higher risk for developing addictive game
play patterns. Preoccupation with video games and trouble disengaging from them
limits the opportunity for learning critical social and problem-solving skills.
This Chapter warns parents and educators about the dangers of video games and
screen-based media and lists steps they can take to minimize the negative
effects of compulsive gaming.

Far too often, parents and
teachers of kids on the autism spectrum focus more attention on teaching
academic and behavior management skills than on daily living skills. Parents
are often surprised to learn that daily living skills are more important than
autism symptoms, language or IQ when it comes to employment and life satisfaction.
Part III (Preparing Your Child for Adulthood) discusses the building blocks for
independent living such as household skills (i.e., cooking, cleaning),
driving or using public transportation, educational/vocational preparation, and
social/community connection. Explicit teaching of these
life skills prior to the transition to adulthood is crucial if we expect kids on the spectrum to have the necessary skills to live independently and negotiate adult life.

The central theme of “The Loving Push” is that the focus of intervention/treatment for spectrum kids must shift to promoting the adaptive behaviors and basic life skills that can facilitate and enhance ultimate functional
independence and quality of life in adulthood. This includes helping them learn the skills needed to meet new
developmental challenges such as independent living, vocational engagement, post-secondary education, and self-supporting employment. Drs. Grandin
and Moore provide a much needed “push” in this direction. As the authors’ note,
“With more and more young adults on the spectrum entering adulthood everyday,
we don’t have time to lose.”

"The Loving Push” is a valuable resource and must read guide to preparing spectrum kids for a successful transition to self-reliance and independence in adult life. The book is not only highly recommended for parents, caregivers, and families, but also for professionals in private practice, schools, colleges/universities, and community settings who work with children, teens, and adults on
the spectrum.

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The objective of bestpracticeautism.com is to advocate, educate, and informby providing a best practice guide to the screening, assessment, and intervention for school-age children on the autism spectrum. Timely articles and postings include topics such as screening, evaluation, positive behavior support (PBS), self-management, educational planning, IEP development, gender differences, evidence-based interventions (EBI) and more. This site also features up-to-date information on scientifically validated treatment options for children with ASD and a list of best practice books, articles, and links to organizations. Designed to be a practical and useful resource, bestpracticeautism.com offers essential information for psychologists, teachers, counselors, advocates and attorneys, special education professionals, and parents.

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“It is rare that one book can pack so many resources and easy to digest information into a single volume! Families, school personnel, and professionals all need the extensive, and up-to-date tips, guides, and ‘must-knows’ provided here. It’s obvious the author is both a seasoned researcher and practitioner – a winning combination.” - Dr. Debra Moore, psychologist and co-author with Dr. Temple Grandin, of The Loving Push: How Parents & Professionals Can Help Spectrum Kids Become Successful Adult

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